Minipill, progestogen pill & Co. – what types of pills are there?

Different types of pills can be prescribed depending on individual needs. These include the combined pill, the mini pill and the progestogen pill. What is the difference between monophasic and multiphasic pills, and what is the difference in duration of use? And how safe are the different types of pills? Find out below.

The combination pill

The combination pill is the type of pill that is most commonly prescribed. It contains both estrogen (ethinyl estradiol) and progestin. Which progestin is included varies from product to product. There is now also a combination pill that, instead of ethinyl estradiol, contains a type of estrogen that provides estradiol – the estrogen that is produced in the body.

The combination pill contains artificial estrogens and progestins. Both hormones are also increasingly produced by the body during pregnancy. When you take the combination pill, your body is “tricked” into thinking that you are pregnant. The artificially supplied estrogen prevents ovulation and an egg cell from developing. The progestin in the pill thickens the cervical mucus. This prevents sperm from reaching the uterus during intercourse.

The  Pearl Index of the combination pill is  0.1 to 0.9. This means that statistically, one to a maximum of nine out of 1,000 women will become pregnant despite taking the pill.

Since the summer of 2021, there has also been a new type of combination pill that contains the progestogen drospirenone and the estrogen estetrol. The latter is a bioidentical hormone, i.e. a hormone whose components are partly obtained from plants, the chemical structure of which is then adapted to the human body in the laboratory.

According to the European Medicines Agency, the known side effects are comparable to those of other combination drugs. Data that suggest a lower risk of thrombosis with the combination of active ingredients are currently being examined further. The Pearl Index of the new combination pill is 0.44.

 

For the microbe

The micropill is also a combination pill. However, the hormone concentration is lower than that of the conventional combination pill. The safety of the micropill corresponds to the Pearl Index of the combination pill.

estrogen free pills

In addition to combination pills, there are also estrogen-free pills. They are primarily prescribed to women who, for some reason, cannot or do not want to take estrogen. They are often prescribed to women who are breastfeeding because only very small amounts of progestin pass into breast milk.

Since these contraceptives do not contain estrogen, ovulation usually continues. A break in administration is not necessary, so estrogen-free pills are taken continuously. Intermenstrual bleeding and spotting are possible, as are shortened or lengthened cycles. In addition, the period can also be missed entirely, even if you are not pregnant.

With estrogen-free pills, a distinction is made between the mini-pill and the higher-dose progestin pill.

 

For mini pills

Due to its low hormone concentration, it hardly influences the body’s hormone production. It contains levonorgestrel or drospirenone.

Since ovulation occurs, fertilization is possible when taking the mini-pill if it is not taken within a fixed time window. Overall, the mini-pill is therefore considered to be somewhat less safe than the combination pill.

Its  Pearl Index is between 0.5 and 3. This is mainly because the effectiveness is guaranteed. The panarantmini-pill is taken within a fixed time frame of three hours.

progestin pills

In addition, there are now higher-dose progestin pills. They contain the active ingredient desogestrel. Due to the higher dosage, the effectiveness decreases, as with the combination pill, if the intake is delayed by at least twelve hours. It is more popular with many women than the mini-pill because it is more flexible to take.

In addition, the higher concentration of progestin prevents the egg cell from maturing. The pearl index of the progestin pill is 0.5 when used correctly.

Monophasic and multiphasic pill

With birth control pills, however, there are not only differences in terms of the hormones they contain but also in terms of their dosage. Most commonly, monophasic (monophasic) pills are prescribed, in which all the pills taken have the same hormone content.

In the case of multi-phase pills (multiphasic), on the other hand, the type of hormones contained and their content change. Therefore, the individual pills must be taken in the correct order. To make it easier to take, the pills have different colours at different stages of the cycle. In contrast to the single-phase pills, the natural fluctuations in the female hormone level are taken into account in the multi-phase pills.

 

Duration of use: 21+7, 24+4 and 26+2

Finally, there are differences in the duration of use of the combination pills. The 21+7 scheme is the most common. The pill is taken for 21 days at a time, after which there is a seven-day break from the pill.

Alternatively, some preparations contain seven placebo pills without an active ingredient so that they can be taken continuously. Menstrual bleeding occurs during the seven days when no pills or placebo pills are taken.

In the 24+4 scheme, hormone-containing pills are taken over 24 days, followed by a four-day break in which placebo tablets are taken. Menstrual bleeding occurs during this time.

A similar system underlies the 26+2 scheme. Here, pills with different hormone concentrations are taken for 26 days. This is followed by two days in which hormone-free placebo pills are taken.